Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury

Detalhes bibliográficos
Autor(a) principal: Carvalho, Alysson Roncally S.
Data de Publicação: 2007
Outros Autores: Jandre, Frederico C., Pino, Alexandre V., Bozza, Fernando A., Salluh, Jorge, Rodrigues, Rosana, Ascoli, Fabio O., Giannella-Neto, Antonio
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/57504
Resumo: João HN Soares helped during the anaesthetic procedure. This work was partly supported by the Brazilian Agencies CNPq, CAPES and FAPERJ.
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spelling Carvalho, Alysson Roncally S.Jandre, Frederico C.Pino, Alexandre V.Bozza, Fernando A.Salluh, JorgeRodrigues, RosanaAscoli, Fabio O.Giannella-Neto, Antonio2023-03-23T00:16:14Z2023-03-23T00:16:14Z2007CARVALHO, Alysson Roncally S. et al. Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury. Critical Care, v. 11, n. 4, p. 1-13, Aug. 9 2007.1364-8535https://www.arca.fiocruz.br/handle/icict/5750410.1186/cc60931466-609XJoão HN Soares helped during the anaesthetic procedure. This work was partly supported by the Brazilian Agencies CNPq, CAPES and FAPERJ.Federal University of Rio de Janeiro. Biomedical Engineering Program, COPPE. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. Biomedical Engineering Program, COPPE. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. Biomedical Engineering Program, COPPE. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clinica Evandro Chagas. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brazil.National Institute of Cancer. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. Clementino Fraga Filho Hospital. Radiodiagnostic Service. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clinica Evandro Chagas. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. Biomedical Engineering Program, COPPE. Rio de Janeiro, RJ, Brazil.Introduction: Protective ventilatory strategies have been applied to prevent ventilator-induced lung injury in patients with acute lung injury (ALI). However, adjustment of positive end-expiratory pressure (PEEP) to avoid alveolar de-recruitment and hyperinflation remains difficult. An alternative is to set the PEEP based on minimizing respiratory system elastance (Ers) by titrating PEEP. In the present study we evaluate the distribution of lung aeration (assessed using computed tomography scanning) and the behaviour of Ers in a porcine model of ALI, during a descending PEEP titration manoeuvre with a protective low tidal volume. Methods: PEEP titration (from 26 to 0 cmH2O, with a tidal volume of 6 to 7 ml/kg) was performed, following a recruitment manoeuvre. At each PEEP, helical computed tomography scans of juxta-diaphragmatic parts of the lower lobes were obtained during end-expiratory and end-inspiratory pauses in six piglets with ALI induced by oleic acid. The distribution of the lung compartments (hyperinflated, normally aerated, poorly aerated and non-aerated areas) was determined and the Ers was estimated on a breath-by-breath basis from the equation of motion of the respiratory system using the least-squares method. Results: Progressive reduction in PEEP from 26 cmH2O to the PEEP at which the minimum Ers was observed improved poorly aerated areas, with a proportional reduction in hyperinflated areas. Also, the distribution of normally aerated areas remained steady over this interval, with no changes in non-aerated areas. The PEEP at which minimal Ers occurred corresponded to the greatest amount of normally aerated areas, with lesser hyperinflated, and poorly and non-aerated areas. Levels of PEEP below that at which minimal Ers was observed increased poorly and non-aerated areas, with concomitant reductions in normally inflated and hyperinflated areas. Conclusion: The PEEP at which minimal Ers occurred, obtained by descending PEEP titration with a protective low tidal volume, corresponded to the greatest amount of normally aerated areas, with lesser collapsed and hyperinflated areas. The institution of high levels of PEEP reduced poorly aerated areas but enlarged hyperinflated ones. Reduction in PEEP consistently enhanced poorly or non-aerated areas as well as tidal re-aeration. Hence, monitoring respiratory mechanics during a PEEP titration procedure may be a useful adjunct to optimize lung aeration.engBioMed CentralPositive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injuryinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlePositive end-expiratory pressure (PEEP)Lung aerationProgressive reduction in PEEPinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZORIGINALve_Carvalho_Alysson_etal_INI_IOC_2007.pdfve_Carvalho_Alysson_etal_INI_IOC_2007.pdfapplication/pdf1006016https://www.arca.fiocruz.br/bitstream/icict/57504/2/ve_Carvalho_Alysson_etal_INI_IOC_2007.pdf23bb2f0746283a54673ff98f4409fde5MD52LICENSElicense.txttext/plain1748https://www.arca.fiocruz.br/bitstream/icict/57504/1/license.txt8a4605be74aa9ea9d79846c1fba20a33MD51icict/575042023-09-04 11:30:21.358oai:www.arca.fiocruz.br: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Repositório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352023-09-04T14:30:21Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)false
dc.title.en_US.fl_str_mv Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
title Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
spellingShingle Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
Carvalho, Alysson Roncally S.
Positive end-expiratory pressure (PEEP)
Lung aeration
Progressive reduction in PEEP
title_short Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
title_full Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
title_fullStr Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
title_full_unstemmed Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
title_sort Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury
author Carvalho, Alysson Roncally S.
author_facet Carvalho, Alysson Roncally S.
Jandre, Frederico C.
Pino, Alexandre V.
Bozza, Fernando A.
Salluh, Jorge
Rodrigues, Rosana
Ascoli, Fabio O.
Giannella-Neto, Antonio
author_role author
author2 Jandre, Frederico C.
Pino, Alexandre V.
Bozza, Fernando A.
Salluh, Jorge
Rodrigues, Rosana
Ascoli, Fabio O.
Giannella-Neto, Antonio
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Carvalho, Alysson Roncally S.
Jandre, Frederico C.
Pino, Alexandre V.
Bozza, Fernando A.
Salluh, Jorge
Rodrigues, Rosana
Ascoli, Fabio O.
Giannella-Neto, Antonio
dc.subject.en.en_US.fl_str_mv Positive end-expiratory pressure (PEEP)
Lung aeration
Progressive reduction in PEEP
topic Positive end-expiratory pressure (PEEP)
Lung aeration
Progressive reduction in PEEP
description João HN Soares helped during the anaesthetic procedure. This work was partly supported by the Brazilian Agencies CNPq, CAPES and FAPERJ.
publishDate 2007
dc.date.issued.fl_str_mv 2007
dc.date.accessioned.fl_str_mv 2023-03-23T00:16:14Z
dc.date.available.fl_str_mv 2023-03-23T00:16:14Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.citation.fl_str_mv CARVALHO, Alysson Roncally S. et al. Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury. Critical Care, v. 11, n. 4, p. 1-13, Aug. 9 2007.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/57504
dc.identifier.issn.en_US.fl_str_mv 1364-8535
dc.identifier.doi.none.fl_str_mv 10.1186/cc6093
dc.identifier.eissn.none.fl_str_mv 1466-609X
identifier_str_mv CARVALHO, Alysson Roncally S. et al. Positive end-expiratory pressure at minimal respiratory elastance represents the best compromise between mechanical stress and lung aeration in oleic acid induced lung injury. Critical Care, v. 11, n. 4, p. 1-13, Aug. 9 2007.
1364-8535
10.1186/cc6093
1466-609X
url https://www.arca.fiocruz.br/handle/icict/57504
dc.language.iso.fl_str_mv eng
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dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
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reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
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